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Problem pot?
Apr 28, 2006

Hi Doc,

My partner's been positive for nearly 5 years now, and I'm negative. We have a great sex life, and intend to continue it! We are regular readers of your forum and we love you!

My question is this, he sometimes has trouble with depression and sleeping. Recently he's been smoking a lot of pot - I reckon about 1/8 every couple of days and I'm worried, is this going to affect his HIV? I mentioned it to him but he says, that it hasn't so far, and if it helps him with other stuff, why not? I can see this is probably fair enough, but am slightly worried all the same. I thought about mentioning it to his doctor as I often go with him but since its illegal, thought it might put his doc in a difficult position. If you could just tell me to 'get a grip,' that'd be great!

Big love to you and dr steve Alex

Response from Dr. Frascino

Hello Alex,

You're a magnetic couple; you have a hot sex life and you are regular readers of this forum. Hmmm . . . I wonder if there is a connection there!?!

Regarding Mary Jane, in moderation I do not believe it has significant deleterious effects. Certainly anything smoked can lead to an increase in respiratory ailments, such as sinusitis or bronchitis. However, unlike cigarettes, there has never been a link between toking on a joint and cancer. I'm a bit concerned that lover-boy has troubles with depression, as marijuana can cause subtle psychological changes.

There is no doubt that marijuana does have beneficial effects, despite the FDA's recent politically motivated announcement that goes contrary to numerous scientific studies documenting marijuana's ability to increase appetite, reduce nausea and decrease intraocular pressure. I'll reprint a few documents about HIV and marijuana below, including one from Dr. Moyle that mentions some of the risks. Personally, I see nothing wrong with sparking a doobie now and then. Of course now that I've said that, I'm sure the DEA will be raiding my home and office sometime soon (. . . knock, knock, knock . . . uh oh! Gotta go!!)

Dr. Bob

Medical Marijuana: Is it Safe? October, 2000

Many people have used medical marijuana to manage symptoms of HIV infection and side effects of therapies. Medical marijuana users assert that the drug is useful in treating nausea, increasing appetite or as a mild analgesic (to help with headaches or mild pain). However, people living with HIV have been left with unclear information as to the risks and benefits of medical marijuana use. A recent study, presented at the Durban Conference, lead to headline news claiming "Medical Marijuana is Safe for HIV Patients." While the study showed that after 21 days the use of medical marijuana did not increase HIV levels, conclusions about the safety of medical marijuana were overstated by the mainstream media.

The study, conducted at the University of California in San Francisco (UCSF) is the first medical marijuana study in people with HIV to be funded by the U.S. Government. Data were presented on 62 people who had completed the 21 day in-patient study. Three times daily, before meals, volunteers received either medical marijuana (smoked/inhaled), dronabinol (Marinol, a pill containing the active ingredient in marijuana) or a placebo. After 21 days there were no differences in HIV levels among those receiving marijuana, dronabinol and placebo. Use of either marijuana or dronabinol resulted in greater weight gain and increased food intake than use of placebo.

Information on the impact of marijuana on CD4+ cell counts and marijuana-HIV drug interactions was not presented. The investigator anticipates this information to be available and presented at a meeting in Toronto later this year.

Commentary

The study was not designed to assess the overall safety of marijuana use for people with HIV, contrary to the implications of the media headlines. Safety of a drug needs to be established through much longer studies looking at both the short- and long-term use of a therapy. It would be irresponsible to suggest that a 21 day study could establish the safety of any drug that is used continually. Further, the safety of interactions between marijuana and other drugs/substances were not established by the study. The use of marijuana in addition to tobacco, for example, is shown to dramatically increase the risk of head and neck cancers. Other research shows that cancer-causing agents in marijuana are much stronger than those found in tobacco. Finally, there is a concern that marijuana bought on the "street" may contain many unknown contaminants, including insecticides or fungus.

The limitations of the current study are well known to researchers at UCSF and they were not responsible for the overstatements made in the media. The group at UCSF plan to develop studies to further assess the safety and utility of marijuana in people living with HIV. For now, the only thing that can be concluded is that short-term marijuana use did not have an effect on HIV levels and that use of either marijuana or dronabinol resulted in greater weight gain than a placebo. This is a far cry from offering proof of the safety of marijuana use. In short, the jury is still out.

Marijuana

November 30, 2005

What Is Marijuana?

Why Do People With HIV Use Marijuana?

How Is Marijuana Used?

What Are the Side Effects?

How Does It Interact With Other Therapies?

How Do We Know It Works?

The Bottom Line

What Is Marijuana?

Marijuana or Cannabis sativa is an herb. It grows in many places around the world. It is also called hemp, reefer, or cannabis. It has had many uses in different cultures. These include reducing pain and increasing appetite. Marijuana contains chemicals called cannabinoids. The best known is tetrahydrocannabinol or THC. The marijuana "high" is mainly due to THC.

Marijuana was used medically in the U.S. until the late 1930s. Then there were claims of "reefer madness." Supposedly, marijuana caused crime, violence, insanity, and death. In 1970, U.S. drug law classified marijuana as having a high potential for abuse and no medical use.

Marijuana was later found to have other health benefits. It can lower pressure within the eye. This helps treat glaucoma, an eye disease which can cause blindness. Marijuana also reduces nausea and vomiting in patients taking chemotherapy treatment for cancer. It reduces muscle spasms in people with nerve problems like multiple sclerosis and can help treat some types of pain. These uses led to the development of the drug dronabinol (Marinol®), a synthetic version of THC.

NOTE: Federal and state laws generally forbid the sale or possession of marijuana. Eleven states have passed "medical marijuana" laws that permit limited use for health reasons. However, in May 2001 the U.S. Supreme Court ruled that medical use of marijuana is illegal under federal law. Federal officials can take action against medical marijuana users or "buyers' clubs" even in states with medical marijuana laws. More information on state medical marijuana laws is available at www.mpp.org/statelaw/index.html.

Why Do People With HIV Use Marijuana?

People with HIV use marijuana to stimulate appetite and to reduce nausea.

Many people with HIV have low appetite. This can be due to fatigue or drug side effects. Low appetite can lead to AIDS wasting (see Fact Sheet 519). Marijuana stimulates the appetite, preventing these problems.

Some people with HIV get nauseated when they take antiviral medications (ARVs). This can make it difficult to take all scheduled doses. Marijuana can help control the nausea. It may also relieve the pain of peripheral neuropathy (see Fact Sheet 555) and is being studied for that purpose.

How Is Marijuana Used?

Normally, dried marijuana leaves and flowers are smoked or baked into food. Doctors can legally prescribe Marinol®. Some people get the same effects from Marinol® as from smoked marijuana. Others prefer to smoke marijuana. They can use just the amount they need without bad effects from higher doses.

What Are the Side Effects?

Smoking marijuana can cause some of the same health problems as smoking tobacco, including bronchitis. However, it has not been clearly linked to lung cancer.

Smoked or eaten marijuana can disrupt balance, physical coordination and visual perception. This can make it dangerous to drive a car or operate machinery. Some people feel stoned (very disoriented or dizzy) when using marijuana. This effect can be stronger when marijuana is eaten than when it is smoked.

Some users develop a tolerance to marijuana. This means they need higher and higher doses to get the same effect. Users can also become dependent on marijuana. They may have mild withdrawal symptoms when they stop using it.

How Does It Interact With Other Therapies?

There are no known interactions between marijuana and medications or other herbs. However, very few interactions between herbs and medications have been studied. Tell your doctor if you are using any herbs or supplements.

A research study found that smoking marijuana does not increase HIV viral load or reduce CD4 cell counts.

How Do We Know It Works?

Many scientific studies document marijuana's ability to reduce nausea, increase appetite, and decrease pressure in the eye.

The Bottom Line

Marijuana is an herb that is smoked or baked into food. It has been used for health purposes for thousands of years. It was legal in the United States until the 1930s. It stimulates the appetite, reduces nausea and some types of pain, and reduces pressure inside the eye. U.S. drug policy made marijuana illegal in 1970. However, doctors can prescribe Marinol®. It is a synthetic version of THC, an active substance in marijuana. Not everyone gets the same results from Marinol® as from marijuana.

Some people with AIDS use marijuana to stimulate their appetites or to avoid nausea when taking their ARVs. A few states have passed medical marijuana laws that permit limited use for health purposes. For more information:

Joy, Janet E., Marijuana and Medicine. Institute of Medicine, 1999. (800) 624-6242, or online at www.nap.edu.

International Association for Cannabis as Medicine

Marijuana Policy Project

National Organization for Reform of Marijuana Laws ________________________________________

does smoking marijuana ? Jan 29, 2004

I am a 31 yr old female, I tested positive in 1995 during routine pregnancy tests. Ive just recently been put back on meds, I was off meds for almost 2 years, I have recently been noticing wasting particularly on my arms and legs. I hardly have an appetite while on meds, Iam 5'3 and I weigh between 115 & 118, been the same weight for the last 5 years.My Tcells were at 354 and my viral load was 50,000 when I was put back on a new regimen My qustion is about smoking marijuana and the possible effects this may have on my health or med regimen the problem is I smoke pot everyday and I eat alot better, but I am worried that this may affet my health in some way in the long run. Do you have any information you can share regarding this matter. Is smoking pot harmful with the HIV therapies?

Thank you for taking your time to answer all our questions.

Sincerely, mimi

Response from Dr. Moyle

Dera Mimi, there are no interactions between marijuana and HIV meds. As you rightly say, many people report increased appetite after smoking marijuana, typically a desire for fatty 'junk' food.(As an aside, one French company is trying to develop a cannabinoid receptor blocker as a treatment for obesity; it causes people to eat less but also eat more healthy food!). Smoking of any sort is potentially harmful to you in terms of long term considerations of lung and heart disease. Long term regular marijuana use is clearly associated with mental illness and possibly more subtle psychological changes. Importantly, it may affect your ability to reliably take your HIV meds. The smoke is also potentially harmful to you child, who will both get the effects of smoke and accumulate some marijuana in their body with repeated environmental exposures. There are marijuana derivatives available via prescription which can help appetite. However, you say you are 'developing wasting' yet you weight is stable for 5 years. If so what do you see to be wasting? I suggest stop the pot and see your doctor and dietitian to see how you can manage your weight better without breaking the law, and potentially harming yourself or your child.

regards Graeme Moyle


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